Cerebral Contusion vs. Concussion

Understanding the Differences Between These Two Types of Traumatic Brain Injury

Head injuries due to falls, collisions, or accidents are a great burden, representing some of the most significant causes of hospitalizations and deaths. Among the most common of such traumatic brain injuries (TBIs) are concussions and cerebral contusions (also known as intracerebral hematoma), a bruising and bleeding of the brain.

While these can be related—and both involve damage to structures of the brain—there are also key differences. Concussion refers to cases of loss of awareness following head injury, whereas cerebral contusion refers specifically to bruising in the brain. Both can result from immediate trauma to the brain, but the latter may also arise due to fracture or can happen without trauma as a cause.

Regardless of the type, TBIs need to be taken seriously. Inflammation and bleeding in the brain associated with both cerebral contusions and concussions can be permanently disabling or even fatal. While these can coexist, just because you have one doesn’t mean you have the other. It’s important to understand how these two conditions are similar and what differentiates them.

Baby having head bandaged at hospital

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What Is a Cerebral Contusion?

Cerebral contusion refers to bruising and bleeding in the brain, typically arising in areas where the cerebral cortex of the brain strikes the skull or dura mater, the tough membrane surrounding the brain and spinal cord. These contusions can arise in any part of the brain, though certain areas—because of their location—are particularly likely to be affected.

The three types most commonly seen are:

  • Anterior fossa floor: The bottoms of the frontal lobes of the brain can be impacted by the walls of the anterior cranial fossa. This is a space in the skull at the front of the head.
  • Temporal pole: This is the part of the brain’s temporal lobe just above the middle cranial fossa, a depression shaped like a butterfly at the base of the skull on each side of the head.
  • Coup-contrecoup pattern: This refers to a type of injury in which contusions occur both on the side of the brain that was directly impacted, as well as on the opposite side (which was affected by a kind of ricochet effect). This pattern is most often seen when the frontal lobes and temporal pole are affected.

What Is a Concussion?

Concussion is a mild traumatic brain injury that, like most contusions, arises from a blow to the head, which can be inflicted due to a fall, sports injury, or accident. Essentially, the brain twists within the skull and hits the sides. This impact is relatively more diffuse, causing nerves and arteries in the head to become stretched and damaged, and there can be longer-term chemical changes.

Although there is some debate about it, concussions are typically classified based on severity, with the amount of time unconscious and the presence of confusion being considered as the defining features:

  • Grade 1: This type of concussion, also known as a “ding concussion,” occurs without loss of consciousness, and with other features and signs of the condition resolving within 15 minutes.
  • Grade 2: More severe are concussions that are not accompanied by loss of consciousness, but other symptoms—including confusion—persist for longer than 15 minutes.
  • Grade 3: This type is accompanied by loss of consciousness, with symptoms persisting longer than 15 minutes.

How Do They Compare?

Both concussions and contusions are considered forms of traumatic brain injury, and while some features of the two are shared, there are key differences:

  • Diffuse vs. focal: Clinically speaking, the two conditions differ in that contusion is considered a focal, or localized injury, whereas concussions are more widespread in their effects. The former, then, entails damage to a more limited part of the brain. However, the scale of that damage tends to be more severe.
  • Causes: Whereas concussions are strictly associated with head trauma, this causes most—but not all—cases of contusion. Additional causes can include longstanding high blood pressure among older people, bleeding problems, as well as the result of taking blood-thinning medications or certain illegal drugs.
  • Bleeding: While some cases of concussion cause bleeding in the brain, others don’t. This is more often associated with cerebral contusion, which by nature causes bleeding, clotting, and pooling of blood.
  • Cognitive and psychological effects: Among the characteristic features of concussion are a wider set of cognitive and psychological effects. Lack of awareness and memory problems, in particular, are associated with this condition, and long-term effects can include psychological symptoms, such as disruptions in sleep patterns and irritability.

Signs and Symptoms

While both cerebral contusion and concussion can share causes—with some symptoms overlapping—there are significant differences in the way the conditions present. Understanding these is essential for both identification and management of these TBIs.

Contusion

The principle symptoms of cerebral contusion arise due to the direct impact of any trauma, as well as subsequent bleeding and swelling, which increases intracranial pressure (pressure inside the skull). Most cases lead to some loss of consciousness, with symptoms arising within 48 to 72 hours of the incident. Patients experience this as:

  • Higher-than-normal blood pressure
  • Dilated pupils
  • Abnormal breathing
  • Slow pulse

Contusions cause symptoms due to the swelling and pooling of blood it’s associated with. These conditions cause significant damage to brain structures and can be fatal if untreated. Here’s a breakdown of what can happen:

  • Cranial edema: As noted, swelling, known as edema, can significantly impact brain and body function. If unchecked, increases in intracranial pressure can lead to a decrease in the level of consciousness, as well as vomiting, headache, weakness or paralysis of the limbs, and uncoordinated or abnormal eye movements.
  • Subdural hematoma: Like edema, hematoma—or pooling of blood—in the brain can lead to confusion and drowsiness, intractable headache, nausea and vomiting, and weaknesses on one side of the body. Dizziness, loss of balance, speech disruptions, memory loss, and personality changes can also arise. If untreated, this progresses to seizures, paralysis, breathing difficulties, and coma.

Concussion

The symptoms of concussion are more wide-ranging. Some symptoms arise within moments of the injury, but others take a couple hours to emerge. Common symptoms include:

  • Headache
  • Nausea and vomiting
  • Confusion and cognitive/memory problems
  • The feeling of being in a “fog”
  • Raised sensitivity to light and sound
  • Disrupted sleep
  • Fatigue and drowsiness
  • Loss of balance and dizziness
  • Depression, sadness, irritability, and anxiousness

Among the populations that most frequently have concussion are young children and toddlers. Parents should keep an eye out for:

  • Bumps forming on the head
  • Excessive crankiness and irritability
  • Lack of appetite or difficulty nursing
  • Changing sleep patterns
  • Increased fussiness
  • Blank stare

In some cases, concussion can lead to longer-term or chronic symptoms, a condition called post-concussive syndrome (PCS). Symptoms of PCS outlast those of primary concussion and include:

  • Inability to concentrate
  • Severe mental problems
  • Changes in personality and increases in irritability
  • Sensitivity to light and noise
  • Disturbed sleep patterns
  • Depression and anxiety
  • Alterations in sense of smell and taste

When to Seek Emergency Care

In general, both concussion and contusion warrant emergency care. What are some signs you should call 911? Here’s a breakdown:

  • Any kind of visible cut or laceration
  • Loss of consciousness for any duration
  • Sleepiness and confusion following the trauma
  • Seizure, vomiting, and severe headache
  • Numbness of the limbs
  • Inability to recognize faces
  • Loss of balance
  • Speaking, hearing, and vision problems

Causes

Concussions and most cerebral contusions are the result of contact or blows to the head. They can also arise due to sudden whipping of the head. They occur to people of all ages, but are most often seen in young children, adolescents, and those over 75.

According to the Centers for Disease Control and Prevention (CDC), the most frequent causes of these and other TBIs are:

  • Falls
  • Motor vehicle accidents
  • Strikes or blows to the face (especially sports injuries)

Notably, in addition to physical injury to the head—which can cause skull fractures, blood clots, and pooling of blood (as in subdural and epidural hematoma)—some cases of cerebral contusion arise without trauma. Bleeding disorders in children, longstanding high blood pressure among older adults, certain medications, as well as some illegal drugs also cause it.

Diagnosis

Diagnosing TBIs like concussion and cerebral contusion is a combination of symptom assessment, physical and mental testing, as well as imaging. Getting a full picture of the scale and severity of the injury often requires multiple stages. Tests and approaches that may be used include:

  • Initial evaluation: If concussion or contusion is suspected, several quick assessments of brain function, called “neuro-checks,” will be performed. On top of assessments of vitals like pulse, providers assess the head for physical signs of injury, check for pupil dilation, and mark other symptoms, such as confusion, loss of consciousness, and fatigue.
  • Glasgow Coma Scale (GCS): The GCS is one of the more popular standardized scales doctors use to assess the severity of the TBI. This involves scoring patients on three measures: speech ability (whether speech patterns or ability is affected), ability to open eyes (whether the person can open their eyes on command), and mobility (ability to move in a coordinated fashion).
  • Categorization: Severity of TBI is based on a combination of GCS score, as well as measures of consciousness and memory. Mild TBIs are defined as loss of consciousness of 30 minutes or less, with memory loss lasting less than 24 hours. Moderate TBIs are cases where the person is unconscious for 30 minutes to 24 hours and has memory problems for up to seven days. Finally, severe TBI is accompanied by loss of consciousness for over 24 hours and memory loss for more than a week.
  • Imaging: To complete diagnosis and allow doctors to get a full sense of the problem, imaging approaches, such as magnetic resonance imaging (MRI) or computerized tomography (CT) scanning, may be used. The latter of these is a set of X-rays of the head from multiple angles; it’s especially useful for visualizing contusions. MRI, which relies on magnetic fields and radio waves to perform imaging, is typically only used in follow-up.
  • Additional tests: Doctors or other providers may also employ some other tests of cognitive function by looking at speech patterns, reading and writing abilities, social communication, and ability to swallow. Tests of cognition—assessing problem solving, reasoning, and comprehension—also help.
  • Blood tests: Emerging in the field are a couple of blood tests that can determine the presence of proteins associated with brain injury. These may be particularly helpful in more mild TBI cases, especially when the issue may not be visible using imaging.

Treatment

The specific management and treatment approaches taken depend on the scale and severity of the TBI. Common approaches include:

  • Rest: The key to full recovery is that you do not return to normal activity until you’re fully recovered, with most seeing recovery within a week. Re-injury of a TBI can make recovery much longer—or even cause permanent damage—which is why you’re only cleared for activity when symptoms have entirely subsided and there’s no sign of problems. Alcohol and drug use can also complicate matters.
  • Blood clot removal: Blood clots and hematoma (pooling of blood) associated with TBI may need to be removed using emergency surgery to limit the scale of damage. These issues can greatly increase pressure on the brain within the skull, stressing structures there.
  • Fracture repair: If there is skull fracture, these need to be surgically repaired as well to prevent worsening of contusions and bleeding. This may mean removing loose pieces and setting the bones of the skull to let them heal.
  • Easing intracranial pressure (ICP): One of the most troubling elements of concussion and cerebral contusion, among other TBIs, is a rise in pressure inside the skull due to hematoma and swelling. Doctors monitor ICP, and if warranted, make a hole or use a shunt to drain excess fluids.
  • Medications: Some symptoms of TBIs can be taken on with medications, with some effective immediately after the incident and others helping in recovery. These include anti-anxiety medications, anticoagulants (blood thinners), anticonvulsants (taking on seizures), antidepressants, diuretics (removing excess fluid from the brain), and muscle relaxers, among others.

While TBIs can be difficult to manage, advances in technologies and techniques have improved outcomes.

Prevention

Put simply, the key to preventing contusions or concussions is to protect your head from injury. Approaches to the prevention of TBI include:

  • Wearing helmets when riding motorcycles, cycling, skiing, and skateboarding
  • Always wearing your seatbelt when in a car
  • Removing trip hazards and improving lighting in the home
  • Installing handrails in the bathroom and on stairs
  • Securing windows and stairways with gates to prevent falls in children

Frequently Asked Questions

Which is more severe—a concussion or a contusion?

Whereas cerebral contusions refer specifically to bruising of the brain, concussions are defined as head injuries resulting in changes in or loss of consciousness. While both concussions and contusions can be fatal or cause permanent changes, concussions tend to lead to a greater range of symptoms and take longer to recover from.

How can you tell the difference between a concussion and a contusion?

Concussions impact multiple parts of the brain, while contusions are localized in one area. The only way to really know whether you have one, the other, or both, is through medical testing and evaluation. Make sure to seek medical attention if you suspect a TBI.

However, there are some ways that the two conditions present differently, including:

  • Symptoms of contusion: Since bruising in the brain causes blood to pool in tissues surrounding the brain, this condition can cause pupil dilation, increase intracranial pressure, lower heart rate, and affect breathing. Numbness and tingling in specific areas, loss of consciousness or coordination, and sleepiness are also common signs.
  • Head trauma: Though head injuries account for most cerebral contusions, they can arise in absence of trauma, as in certain cases of high blood pressure or taking certain medications. Concussions, however, are defined as arising from head injuries.
  • Cognition and TBIs: While more severe forms of both of these TBIs can affect cognition, contusions—especially if accompanied by edema—are more frequently associated with slurred or disrupted speech and memory problems. That said, severe concussions can also cause these symptoms.
  • Symptoms of concussion: Concussions lead to symptoms that may not present in cerebral contusion cases, such as ringing in the ears, dizziness, light and sound sensitivity, and changes in personality. Nausea and vomiting are two other hallmarks not necessarily seen in contusion cases.

How do the signs of contusion differ from those of a concussion?

While the signs of contusion and concussion overlap—especially as they become more severe—there are key differences. Contusion symptoms that aren’t usually shared with concussion include:

  • Lower pulse
  • High blood pressure
  • Dilation in one or both pupils
  • Affected breathing
  • Tingling in the limbs

Some other contusion symptoms, however, like memory problems and changes in personality, are also seen in moderate and severe concussions.

A Word From Verywell

Ultimately, TBIs like concussion and cerebral contusion are a consistent and common medical problem. In 2019, this type of injury was the cause of nearly 61,000 deaths in the United States.

It’s therefore critical that you seek immediate medical attention following any kind of blow or impact to the head. Further, remember that your doctor and medical team are there to help; check in with them whenever you have questions or concerns regarding TBI.

While there are certainly challenges when it comes to TBIs, it’s important to note that outcomes have improved as awareness of these conditions has grown and treatments have evolved. Recovery can be challenging; however, concussion and cerebral contusion can be properly and effectively managed. 

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